# The Effects of Multimodal Prehabilitation on Postoperative Outcomes in Colorectal Surgery: A Systematic Review and Meta-Analysis

## TL;DR

Multimodal prehabilitation before colorectal surgery improves recovery and reduces complications, but more research is needed on its impact on severe complications.

## Contribution

This study provides the first meta-analysis on the effects of multimodal prehabilitation in colorectal surgery.

## Key findings

- Prehabilitation reduced overall postoperative complications compared to standard care.
- Functional recovery improved by 50.8 meters in the six-minute walk test.
- No significant effect on severe complications was observed.

## Abstract

Colorectal surgery carries risks of functional decline and complications. Multimodal prehabilitation, integrating exercise, nutrition, and psychological support, may enhance recovery alongside Enhanced Recovery After Surgery (ERAS) pathways. This review evaluated its impact on postoperative outcomes.

A systematic review and meta-analysis were conducted using a standardized and transparent methodology to ensure comprehensive and unbiased reporting. PubMed, Embase (via Ovid), MEDLINE (via Ovid), and Cochrane Central were searched for randomized controlled trials (RCTs). Eligible trials compared multimodal prehabilitation with standard care in elective colorectal resections. The primary outcome was overall postoperative complications; secondary outcomes included functional capacity by the six-minute walk test (6MWT) and severe complications (Clavien-Dindo ≥III). Five RCTs (422 patients) were included. Prehabilitation significantly lowered overall postoperative complications compared with standard of care (OR: 0.60, 95% CI: 0.42-0.86; p=0.02; I²=0%). Functional recovery was improved, with a pooled mean 6MWT difference at eight weeks of +50.8 m (95% CI: 25.9-75.7; p<0.0001; I²=59%). No significant reduction was observed for severe complications (OR: 0.65, 95% CI: 0.13-3.29; p=0.37; I²=20%). Multimodal prehabilitation improves functional recovery and reduces overall complications in colorectal cancer surgery, though its effect on severe complications remains uncertain. Larger multicenter trials are needed to strengthen the evidence base.